Anatomical reconstruction of reverse hill-sachs lesions using the underpinning technique.

Full article available online at Healio.com/Orthopedics. Search: 20120426-35 Posterior glenohumeral joint dislocation is an uncommon injury and is associated with bony and ligamentous disruption. It requires prompt diagnosis and early treatment to prevent acute or recurrent instability and subsequent dysfunction. Reverse Hill-Sachs lesions associated with this injury are challenging to treat, and optimal treatment is controversial. Treatment methods can be divided into those that achieve stability through muscle transfers, osteotomies, or posterior bone-block procedures (glenoid augmentation) and those that restore the sphericity of the humeral head. Joint replacement is often suggested for large head lesions (.50%) considered beyond reconstruction. Restoration of stability, preservation of the proximal humeral anatomy, and salvage of the humeral head sphericity should be the treatment goals in the younger population. This article describes the surgical technique of elevation of the impressed osteochondral fragment followed by filling the lesion with Allomatrix bone graft putty (Wright Medical Technology, Arlington, Tennessee) in 2 patients. The size of the head lesion was <35%. Underpinning raft screws were used to provide subchondral support and prevent the collapse of the elevated fragment. Postoperatively, the sphericity of the humeral head and glenohumeral stability were restored. No evidence of collapse, osteonecrosis, or osteoarthritis progression was seen at latest follow-up. Functional results were excellent, with a minimum follow-up of 2 years. This technique is an alternative method of restoring humeral head sphericity in patients with acute posterior glenohumeral joint dislocations with medium (20%-40%) reverse Hill-Sachs lesions. Drs Banerjee, Singh, Das, and Patel are from the Department of Trauma and Orthopaedics, Epsom and St Helier Hospitals NHS Trust, Surrey, United Kingdom. Drs Banerjee, Singh, Das, and Patel have no relevant financial relationships to disclose. The authors thank Dr Shubhasree Dutta Choudhury for helping with the illustration of the surgical technique. Correspondence should be addressed to: Samik Banerjee, MBBS, MS(Orth), MRCS, Department of Trauma and Orthopaedics, Epsom and St Helier Hospitals NHS Trust, Wrythe Ln, Carshalton, Surrey, United Kingdom (bashb02@gmail.com). doi: 10.3928/01477447-20120426-35 Anatomical Reconstruction of Reverse Hill-Sachs Lesions Using the Underpinning Technique Samik Banerjee, mBBS, mS(Orth), mrCS; Vinay kumar Singh, mrCS, mCh, Dip Sem; aBhiShek kumar DaS, mBBS, mS(Orth), DnB(Orth); Vipul r. patel, mS(Orth), FrCS, FrCS(Orth) e752 Figure: Postoperative anteroposterior radiograph showing reconstruction of the reverse Hill-Sachs lesion and stabilization of the proximal humeral fracture with a PHILOS plate (Synthes, Solothurn, Switzerland).